PB2619: THE IMPACT OF ITP-DIRECTED TREATMENT ON FATIGUE AMONG CHILDREN AND ADOLESCENTS WITH CHRONIC ITP: DATA FROM THE ITP NATURAL HISTORY STUDY REGISTRY
Authors: Jennifer Diraimo, Caroline Kruse, Alexandra Kruse, Kevin Doyoon Won, Rachael F. Grace
Journal: HemaSphere (2023)

Topic: 32. Platelet disorders Background: Immune thrombocytopenia (ITP) is an acquired autoimmune disorder associated with risk of bleeding, poor quality of life, and fatigue. Despite its common occurrence, why fatigue occurs in ITP remains unclear. Limited information exists on how ITP-directed treatment may impact fatigue in different pediatric age groups. Aims: To compare how treatment impacts fatigue in children (age 1-12) and adolescents (13-18) with ITP using prospective registry data. Methods: Forty-four participants (≤18 years) were enrolled on the ITP Natural History Study, a patient-consented and completed web-based registry, through November 2022. Survey responses capturing fatigue were based on in the prior seven days, while treatment use was reported for the prior 6 months. Surveys were completed by caregivers with patient input. Data analysis was performed using Pearson Chi-square and Fisher exact tests. Results: Survey responses were completed for 28 children and 16 adolescents. All 33 participants who reported their date of diagnosis had chronic ITP, with 73% (24/33) being diagnosed for >2 years. Twenty-seven participants received treatment within the last six months; 8 (5 children, 3 adolescents) received a first-line ITP therapy and 19 (10 children, 9 adolescents) received a second-line therapy. Most participants reported feeling ‘tired easily’ (72.7%, 32/44). More adolescents (62.5%, 10/16) felt ‘too tired for sports/exercise’ compared to children (48.1%, 13/27), and significantly more adolescents felt ‘too tired to do schoolwork’ compared to children (81.3%, 13/16 vs 44%, 11/25, p=0.025). When participants were stratified based on use of ITP treatment, those receiving ITP-directed medication reported lower levels of fatigue compared to participants who were observed without medication. Adolescents and children who did not receive ITP-directed medication, were more likely to report they were ‘too tired for schoolwork’ than those receiving medication (87%, 13/15 vs 59%, 16/27, p=0.07), and more likely to feel ‘too tired for exercise/sports’ (82%, 14/17 vs 67%, 18/27). Stratified by age, adolescents treated with ITP-directed medication indicated they felt ‘too tired for sports/exercise’ less than adolescents not taking medication (55%, 6/11 vs. 100%, 5/5). Children receiving ITP-directed medication reported they were ‘too tired for sports/exercise’ at a similar frequency to those observed without medication (71%, 10/14 vs 75%, 9/12). Summary/Conclusion: Conclusion: Fatigue is common in both adolescents and children with ITP with participation in sports and schoolwork completion being particularly affected. Interestingly, adolescents appeared to be impacted more severely than children. Our data suggests that ITP-related fatigue and its associated effects in adolescents may be responsive to ITP-directed treatment in pediatric participants. Study results are limited in statistical significance likely due to a small sample size. Other limitations include possible bias from patient centered responses. Keywords: Immune thrombocytopenia (ITP), Pediatric, Fatigue